The regional workshop "Promoting access to HIV testing and counselling services for injecting drug users in the Baltic States" took place on 10 December 2010 in Vilnius and gathered decision-makers and practitioners from Lithuania and Latvia, as well as representatives of international organizations and researchers and service providers from Ukraine and Spain. The workshop was organized jointly by the United Nations Office on Drugs and Crime (UNODC) Project Office for the Baltic States and World Health Organization (WHO) Regional Office for Europe.

The workshop was opened by the Head of EU Affairs and International Relations Division of the Lithuanian Ministry of Health Mr. Viktoras Meižis who stressed importance of international expertise in assessing problem areas. Experts from Lithuania and Latvia (Estonian delegation could not attend the meeting due to cancellation of their flight) had prepared a comprehensive overview about the current situation and challenges for HIV testing in their countries. One of the problems in Latvia is lack of information about availability of HIV rapid tests in regional birth clinics and STI treatment facilities. The proportion of unknown HIV transmission mode still remains high, and there is a concern that around 60% of AIDS cases have been diagnosed 1 to 3 years after HIV diagnosis. Director of the Centre for Communicable Diseases and AIDS in Lithuania Mr. Saulius Čaplinskas described situation in Lithuania and noted that HIV testing among drug users, sex workers and MSM has been extremely low in 2010.

Ms. Lali Khotenashvilli from WHO Regional Office for Europe pointed-out that it is very important to improve HIV testing accessibility for most-at-risk groups and to expand HIV testing beyond health care settings. At the same time she stressed that HIV testing is never a goal in itself, it is important to carry-out comprehensive prevention, as well as to ensure HIV treatment for those in need. All these issues should be clearly addressed in supportive social, policy and legal framework.

Mr. Mika Salminen from European Centre for Disease Prevention and Control noted that according to the latest estimates around 30% of people infected with HIV in Europe are unaware of their infection, which results in late HIV diagnosis and missed opportunity for timely access to treatment and care. He reminded that effective national approach to HIV testing should rely on understanding of the epidemic. Testing programmes should aim to reach those at risk of infection and to prioritise those at highest risk. Any legal and financial barriers preventing uptake and effectiveness of HIV testing should be removed.

An excellent example of successful provision of HIV testing and other services for most-at-risk groups in Barcelona (Spain) was presented by Mr. Ferran Pujol, Director of NGO "Hispanosida". "Hispanosida" established BCN Checkpoint for MSN in 2006. It is located in the centre of Barcelona and provides a wide range of services for MSM, including HIV testing and counselling. Since the first day of operation, the demand for rapid tests has increased dramatically. In 2009, nearly 6000 HIV rapid tests have been performed in community-based centres in Catalonia and nearly half of them in the BCN Checkpoint. Due to extensive training of personnel, especially community educators, service quality control and attractive campaigns, it has been possible for BCN Checkpoint to reach significant number of MSM.

Presenters from Ukraine Ms. Irina Grishyeva (Clinton Health Access Initiative) and Ms. Olena Maksymenok (Academy of Medical Science of Ukraine) shared their experience in evaluation of effectiveness of HIV rapid tests and subsequent scaling-up of HIV testing in Ukraine. They explained that before 2009 rapid HIV test results were barely used in Ukraine mainly because clinicians had negative attitude towards them. Meanwhile conventional HIV testing was not easy accessible, especially for injecting drug users who were the driving force of HIV epidemic in Ukraine. To address this situation a project aimed to assess effectiveness of rapid tests and to develop algorithm of HIV testing was launched. The results of the project showed that rapid tests have high sensitivity, specificity and positive/negative predictive value, as well as they are efficient tool for reaching high risk groups. Based on the project results Ukrainian Ministry of Health allowed to use rapid tests for diagnosis of HIV in line with algorithm of 2 serial rapid tests.

At the end of the workshop participants from Latvia and Lithuania identified the main barriers to scaling-up and increasing uptake of HIV testing among injecting drug users (IDUs) and prepared their recommendations on ways to overcome them. Latvian recommendations were mainly based on revision of legal framework by clarifying who is responsible for the establishment of low-threshold services for injecting drug users and stating that it is a family doctor's duty to offer HIV testing to the patient. Latvians also thought that it is essential to educate social workers and health care personnel about HIV and harm reduction, as well as to provide targeted information and education to the IDUs. Lithuanian participants pointed to the problems related to the confirmation of reactive rapid tests and referral to HIV treatment. The main barrier to scaling-up HIV testing in Lithuania is lack of funds and limited access to testing for injecting drug users and men who have sex with men. They suggested that the government should purchase rapid HIV rapid tests and cover HIV testing expenses, as well as make amendments in legal acts in order to expand possibility to use of HIV rapid tests in non-medical settings.